Anger, Guilt May Trigger Stroke

Every 45 seconds, someone in the U.S. has a stroke, according to the American Stroke Association. Stroke is America's no. 3 cause of death -- after heart disease and cancer -- and can also cause severe, permanent disability.

Stroke has many well-known risk factors, including heart disease, smoking, and high blood pressure. Those conditions can set the stage for stroke, but less is known about how emotions can affect stroke.

Emotional and mental stress, along with sudden body position changes, have been tied to heart attacks. Could the same also be true for stroke?

To find out, 200 stroke patients were studied by researchers including Silvia Koton, PhD, MOccH, RN, of The Israel Center for Disease Control. Only stroke survivors who were able to communicate were eligible.

Participants were about 68 years old. Their biggest risk factors were smoking and high blood pressure. Most had ischemic stroke, the most common kind of stroke, in which the brain's supply of oxygen-rich blood is blocked by a blood clot.

Participants were interviewed one to four days after their stroke. The researchers focused on seven possible risk factors: negative and positive emotions, anger, heavy eating, heavy physical exertion, sudden body position changes due to a startling event (such as standing up suddenly at a loud noise or a grandchild's cry), and sudden temperature change.

Nearly 30% of participants reported at least one of those experiences two hours before their stroke. The results, which appear in the Dec. 14 issue of Neurology, held after factoring in smoking, diet, and medications.

Key Time Frame

The two hours before the stroke seemed important. Anger, negative emotions, and sudden body position changes were especially significant then, compared with the day before the stroke or a typical day in the last year.

Negative emotions were the most common possible trigger. Positive emotions, in contrast, had no effect. "It is possible that negative emotions evoke more intense reactions," say the researchers.

There was a 14-fold increase in stroke risk with both negative emotions and anger. Change in body position increased stroke risk 24 times.

People experience emotions differently, so participants rated how they felt. For instance, the angriest people could choose between "very angry," "furious," or "enraged" to describe their emotional state.

Don't draw long-term conclusions about emotions and stroke, say the researchers. They gauged the immediate connection between stroke and emotions. It's not known how years of negative feelings and anger affect stroke risk.